tbuckley/cabot-search huggingface dataset:
Health literacy screening in pediatric oncology and stem cell transplant caregivers: A cross-sectional cohort study.
Authors: Alycia R Foti, Melissa Parsons Beauchemin, Yujing Yao, Zhezhen Jin, Justine Kahn
Journal: Journal of Clinical Oncology (2022)

155 Background: Despite advances in childhood cancer outcomes, disparities among socially vulnerable populations persist. Associations between educational attainment, English proficiency and outcomes suggest that factors impacting communication and comprehension may contribute. Health literacy (HL) is the degree to which individuals can process and act on health information. It is reported that up to 35% of adults in the U.S. have limited HL, with prevalence rising to 50% in those from low-income households. While studies from medical oncology report associations between limited HL and inferior outcomes, there remains a paucity of data on HL rates and associated outcomes in pediatric oncology and stem cell transplant (SCT) populations. We evaluated HL rates in a group of pediatric oncology and SCT parents/caregivers at a large academic medical center, and explored associations with self-reported demographics. Methods: English or Spanish-speaking parents of children (1 – 18 years) receiving chemotherapy or SCT were eligible. Self-reported sociodemographics were collected via survey, and HL was measured via bilingual interview using the Newest Vital Sign screening tool. Scores indicating likelihood of limited (0 – 1), moderate (2 – 3) and high (4 – 6) literacy were calculated and associations between HL, demographics, social determinants of health, and clinical characteristics were explored. Results: In total, 48 caregivers had evaluable HL and demographic data; 33% were Hispanic, 27% were non-Hispanic Black, and 25% were Spanish speaking only; 53% had public insurance, and 12% did not complete high school. Forty-four patients (90%) had cancer, 51% of whom had leukemia or lymphoma. Mean HL score was 3.27 (+/- 1.90). Nine caregivers (18%) had limited HL, 18 (37%) had moderate HL, and 21 (43%) had high HL. When comparing the limited/moderate HL group to the high HL group in univariate analysis, a significantly higher proportion of those in the limited/moderate group were Spanish speaking only (p = 0.035), received less than a high school education (p = 0.002), were unemployed (p = 0.038), and endorsed material hardship (e.g., food insecurity) (p = 0.001). Across all participants, 69% sought information about their child’s diagnosis from providers, and 55% sought information from the internet. Conclusions: Among this diverse population of pediatric oncology and SCT caregivers, over 50% are at risk of limited HL. Univariate models indicate that limited literacy is associated with Spanish language preference, low educational attainment, and material hardship, however larger patient numbers are needed to evaluate adjusted associations. Analyses measuring the contribution of HL to clinical outcomes are ongoing, with early results indicating that interventions addressing both material hardship and limited literacy are urgently needed.
Uptake in genetic testing in patients with pancreatic cancer with oncologist-driven testing protocol.
Authors: Traci King, Page Widick, Rodrigo Paredes, Oliver Klein, Jill Krejdovsky, Nadine M. Tung, Mary Linton Bounetheau Peters
Journal: Journal of Clinical Oncology (2022)

33 Background: The objective was to compare the uptake of genetic testing in patients with pancreatic adenocarcinoma (PDAC) seen at a single center (1) before the 2019 NCCN recommendation of universal screening for genetic mutations in all new PDAC diagnoses, (2) after this change in guideline, and (3) after transitioning to an oncologist-driven genetic testing protocol. Methods: A retrospective review of patient records seen for a new PDAC diagnosis at BIDMC between May 2018-May 2022 was performed. Patients were categorized into three groups by date of visit: pre-guideline change (5/2018-4/2019), post-guideline change (5/2019-12/ 2020), and after implementation of an oncologist-driven testing protocol (12/ 2020-5/2022). The primary outcome was the differences in rates of testing between each time period. Results: An increase in rates of genetic testing occurred between each successive time period. Pre-guideline change, 22% of patients had testing sent, and this increased to 32% post-guideline. With the oncologist-driven testing, this increased to 73%. There was an increase in referrals for genetic testing from the pre- to post-guideline change time periods (42% to 61%). However, in both groups, the number of patients who completed testing was approximately half of those who were referred (23% and 34%, respectively). Conclusions: Our cancer center moved to oncologist-driven testing to increase uptake in the wake of a guideline change recommending universal testing of all PDAC patients. By this protocol, germ-line testing is sent by the medical oncologist at the initial multidisciplinary clinic visit, rather than following a consultation with our genetic counseling team. With this change, there was a dramatic increase in genetic testing (32% to 73%), thereby capturing approximately 10 additional patients with actionable pathogenic variants. However, this change necessitated additional resources in the multidisciplinary clinic and time from the oncologist to consent for testing. In addition, the expertise of cancer genetics counselors was not provided to all patients. We attempted to address the latter via selective referral after positive results. Despite these trade-offs, oncologist-driven testing successfully met the goal of increasing our adherence with guideline-based genetic testing of all PDAC patients.[Table: see text]
Low-risk episode characteristics with an impact on total cost of care and performance in the Oncology Care Model.
Authors: Puneeth Indurlal, Jody S. Garey, John Russell Hoverman, Lydia Mills, Judi Payne-De Bock, Stuart Staggs, Lalan S. Wilfong
Journal: Journal of Clinical Oncology (2022)

12 Background: The Oncology Care Model (OCM) is an episode-based, Medicare value-based care program, that rewards providers for decreasing the total cost of care (TCOC) compared to a benchmark price. The model differentiates breast &amp; prostate cancer treated with hormone-only therapy, and bladder cancer treated with Bacillus Calmette-Guérin and/or mitomycin as low-risk episodes (LRE). All other qualifying cancers, including breast, prostate &amp; bladder cancer treated with chemotherapy are designated as high-risk episodes (HRE). Independent evaluation of OCM Performance Periods (PP) 1-6 suggests that reductions in TCOC predominantly occurred in HRE but were offset by increased TCOC in LRE. We seek to evaluate the episode characteristics that have a bearing on LRE performance in OCM. Methods: Episode claims data for 14 practices in The US Oncology Network (The Network) participating in OCM during PP 1-6 were assessed. Several episode characteristics including patient age, gender, comorbidities, cancer type, oncology touchpoints, etc. were evaluated. Results: LRE accounted for 30.5% of total episodes for The Network in OCM from PP1-6, with average benchmark price of $6,700. 85% of LRE were breast cancer patients with average benchmark of $5,800. Only 30% of LRE had increased TCOC exceeding benchmark. Average TCOC increased gradually with increasing age, with highest TCOC at extremes of patient age (18-64 and 80+). Episodes with multiple comorbidities (defined as Hierarchical Condition Category (HCC) flags 3, 4-5, 6+) had an average TCOC 3-times higher than episodes with fewer-or-no comorbidities (HCC flags 0, 1, 2). Episode expenses beyond cancer care (inpatient, nursing facility, home health, long term care, durable medical equipment, and inpatient rehabilitation) were 2.5 times higher for patients with advancing age (75-79 or 80+) and multiple comorbidities. Additionally, these patients had lower physician services expenses, fewer oncology care touchpoints (defined as visits with the Oncology practice), and a four-fold higher death rate. Conclusions: In the OCM, LRE for older patients with multiple comorbidities had higher TCOC, with fewer oncology touchpoints, higher death rates, and episode expenses beyond cancer care contributing the most to TCOC. Incorporating a comprehensive geriatric assessment (composed of physical, functional, cognitive, mental, and socioenvironmental factors) could guide oncologic therapeutic choices, and appropriate clinical management of these patients to improve outcomes. In addition, a modified, resource utilization-based risk adjustment approach could better fit this population.
Reducing central-line associated bloodstream infections (CLABSIs) through patient accountability contracts: A pilot project for patients on Weill Cornell Medicine (WCM) bone marrow transplant (BMT) service.
Authors: Christine Ann Garcia, Stefanie Taflin, Dianna Assalone, German Rodriguez, Catherine McHugh, Barbara Whitmore, Christine Hatola, David P Calfee, Tsiporah Shore
Journal: Journal of Clinical Oncology (2022)

283 Background: Patients with cancer whom develop Central Line Associated Blood Stream Infections (CLABSIs) have increased mortality rates ranging from 12% to 40%. Transplant patients are particularly at risk due to cytotoxic chemotherapy regimens and/or graft-versus-host disease with risk for translocation of oral and gut flora to the bloodstream. At Weill Cornell Medicine, we had 102 CLABSIs in 2021, 25 (25%) of which attributed to patients in oncology units. The Bone Marrow Transplant (BMT) Unit, had 10 of the 25 (40%), 2.05 CLABSIs per 1000 central line inpatient days with a CLABSI standardized infection ratio (SIR) of 1.26 (above goal of 1). Methods: Our SMART aim was to reduce the number and rate of CLABSI events on the BMT unit by 10% from February 1, 2022 – June 30, 2022 by educating patients on preventive strategies and implementing a patient central-line maintenance “contract.” We had previously optimized evidence-based nursing interventions for CLABSI prevention which included adherence to central line maintenance best practices, weekly device rounds with Infection, Protection &amp; Control to monitor compliance with dressing changes and IV tubing, annual CLABSI prevention competencies, peer-to-peer validation of blood culture lab draws, weekly quality-improvement huddles and interdisciplinary root cause analysis discussions for CLABSI events. Patient noncompliance with daily recommendations for central line care was identified as a possible CLABSI risk factor that was not previously addressed in the bundle. Newly-developed patient education and a “contract” was incorporated into the BMT admission process. Results: The BMT CLABSI patient education and contract was initiated with all new patients admitted to unit in February 1, 2022. Since starting, the BMT unit CLABSI SIR has decreased from 1.26 to 0.6, and from a CLABSI rate per 1000 central lines days of 2.05 to 0.97. Conclusions: Engaging patients in their own care of the central lines can significantly reduce overall risk of central line infections. Patients have positively responded to this pilot project. We have translated educational materials and contracts to other languages and are considering expansion into other units.
Gender analysis of oncology expert participation on online professional platforms.
Authors: Jessica Kunzman, Elizabeth Henry, Nadine Housri, Sophia C. Kamran, Pamela L. Kunz, Lauren E Lee, Noelle K. LoConte, Lindsay Burt
Journal: Journal of Clinical Oncology (2022)

350 Background: Social media platforms have been highlighted as a tool to help promote gender equity by amplifying women in medicine and providing means for collaboration and networking. However, limitations of social networks include sexual harassment and persistent gender biases. While the number of female trainees entering oncology specialties has mostly equalized, gender disparities persist among faculty in promotion, publishing, and leadership positions. We sought to characterize the engagement of female and male oncologists via a private, moderated knowledge-sharing platform, theMednet.org, which disseminates expert knowledge via question-and-answer format. Methods: Questions were posted by registered oncologists on theMednet.org and reviewed by a team of physician editors who then invited selected experts to respond. Experts were selected by the editorial team based on research prominence, academic rank, leadership, and other expert recommendations. Physician information, such as role (academic, community, or trainee), specialty (radiation oncology (RO), medical oncology (MO)), questions asked, and questions answered were analyzed from June 2014 through June 2022. The gender of each physician was determined from their associated National Provider Identifier (NPI), which is recorded as female or male; users without an associated NPI were excluded from the data set. Statistical significance was determined through unpaired two-tailed T-tests and chi-squared testing. Results: Among RO and MO physicians, 3376 were identified as female and 6011 were identified as male. Female faculty make up 42% of experts, which was proportionate to the percent of female users. Female and male experts were invited to answer questions at similar rates for all specialties; however, male experts answered questions at a statistically significantly higher rate in RO (51% vs 18%) and MO (27.5% vs 14%) (Table). Conclusions: While female and male experts were equally invited to answer questions, male experts were significantly more likely to answer questions. As online platforms are increasingly raising the prominence of academics on a national level, lower engagement by female experts may further compound gender disparities in academia. Further studies should identify actual and perceived barriers to female experts answering questions and interacting on professional platforms.[Table: see text]
Improving patient satisfaction and care delivery for female veteran patients with cancer receiving outpatient infusion therapies.
Authors: Malinda T West, Gagah Tamba, Rajat Thawani, Antonene Drew, Rose Cheng, Nicole V Wilde, Julie N Graff, Rosemarie Mannino
Journal: Journal of Clinical Oncology (2022)

279 Background: Our objective was to explore if differences in patient satisfaction based on gender exist in a Veterans Health Administration (VHA) outpatient chemotherapy infusion unit. Methods: Veterans who received outpatient infusion treatments from 2018 to 2020 were contacted by phone and agreed to partake in an anonymous 25 question online survey. Response differences were analyzed using Fisher’s exact and Welch's t-tests. Results: 69 veterans were contacted. 70% (21/30) of women and 51% (20/39) of male veterans completed the survey. Most women were &lt; 65 years (62%), and 52% treated for breast cancer. 90% of men were &gt; 65 years old, majority treated for prostate cancer (20%) or a hematological cancer (20%). Using our survey, patient satisfaction was 8.71/10 points (± 0.60) in women vs. 9.55 (± 2.24) in men (p = 0.113). 86% of women endorsed hx of sexual abuse or harassment vs 10% of men (p &lt; 0.001). More women vs men felt uncomfortable around other patients and unable to voice uncomfortable experiences to a provider in the infusion unit (p &lt; 0.05). Not statistically significant but potential clinical importance was more women felt uncomfortable around the offending gender (29% vs 0%), more women felt greater emotional support and importance with access to a tx room with the same gender (29% vs 0%), and more women preferred access to a gender specific restroom (30% vs 20%). Conclusions: Gender appears related to how veterans with cancer perceive their ambulatory cancer care. This may be due to the combination of high sexual abuse and/or harassment hx amongst women who are a minority of the total infusion unit population, the majority of whom receive tx for a primarily gender specific breast malignancy. Analysis was limited by the small sample size of women, many with advanced malignancy. Ongoing initiatives based on these survey results are underway and may be applicable to other outpatient cancer center facilities where patient demographic and infusion unit design may be similar.[Table: see text]
Quality initiative to improve lung cancer screening in a Veterans Affairs medical center.
Authors: Laura Miotke, Audrey York, Alicia Bowles, Farrah Lewis-Williams, Emily Beck
Journal: Journal of Clinical Oncology (2022)

108 Background: In 2013 the US Preventative Services Task Force recommended lung cancer screening (LCS) with low-dose CT (LDCT) scans in high-risk populations. Eight VA Medical Centers (VAMC) successfully piloted LCS in a demonstration project and several additional VA sites have since launched LCS programs, including the Salt Lake City VAMC. These systems utilize the “Clinical Reminder System” (CRS) in the electronic medical record to enroll patients into the LCS program which allows LDCTs to be tracked by a nurse coordinator. As these programs are relatively new, improvements and shared knowledge is imperative to optimizing the success of LCS programs. Methods: Our intervention was to change the radiology ordering menu to encourage providers to order LDCTs through the CRS, thus enrolling patients in the LCS program. We examined the percentage of LDCTs performed within the LCS screening program as our process measure. We then chose three outcome measures based on recommendations proposed by a national cancer roundtable: 1) Percentage of Lung-RADS 1 or 2 diagnoses with follow-up within 15 months, 2) Percentage of Lung-RADS 3 diagnoses with follow-up within 8 months and 3) Percentage of Lung-RADS 4 diagnoses with follow-up within 18 weeks. We compared outcome measures between LDCTs performed within the LCS program and those performed outside of the program. Results: We compared a total of 492 LDCTs during a pre-intervention six-month period to the 544 LDCTs performed in the first 6 months after our intervention. Pre-intervention, 54% of LDCTs were performed through the LCS program, compared to 79% post-intervention (p &lt; 0.001). The percentage of Lung-RADS 1 or 2 scans with appropriate follow-up time was significantly better within the LCS program (70%), compared to scans performed outside the program (49%, p &lt; 0.001). There was no statistical difference in follow-up of Lung-RADS 3 or 4 scans. Conclusions: Through this work we learned the CRS is non-intuitive and used with variable comfort within the VAMC. As such, a simple intervention guiding ordering providers from the radiology ordering menu to the CRS was effective in increasing enrollment and adherence to follow up in a VA system LCS program. LCS is complex compared to other cancer screening programs. Many primary care providers and radiologists alike are uncomfortable managing these patients. As such, enrollment in a standardized LCS program and early involvement of a multi-disciplinary team is imperative. Not only did we demonstrate this with our outcome measures, but while examining the system we uncovered many inappropriate follow-up scans, biopsies, and oncology consults that contribute to waste. As lung cancer screening programs continue to evolve, quality improvement projects such as this will help improve lung cancer care and outcomes.
Impact of statewide telemedicine support model in a community oncology practice.
Authors: Sydney Townsend, Blake Hoegger, Lance Ortega, Debra A. Patt, Holly Books, Sabrina Q. Mikan
Journal: Journal of Clinical Oncology (2022)

391 Background: While there was broad adoption of telemedicine during the COVID-19 pandemic, optimizing the interaction for patients and the clinical team remained a challenge. We sought to optimize delivery of telemedicine services to provide more efficient and effective patient care. Target areas of concern for improvement were scheduling, staffing, communication, technical challenges with operating the platform, a high cancellation rate, and limited copay collections. Methods: A team of 8 virtual Patient Service Coordinators (VPSCs), 8 virtual Medical Assistants (VMAs), and an RN clinical manager was created to work remotely from home to serve Providers at 8 clinics. VPSCs performed check-in duties, demographics, copay collection and technology trouble-shooting with patients. VMAs performed medical intake (medication reconciliation, depression screenings, and vital signs) with real-time EMR input. VMAs stayed in-touch with patients to communicate Provider delays. Standardized communication pathways connected virtual teams with in-clinic teams. The clinics selected to participate in the TMS program were conducting 29% - 50% of E&amp;M visits by telemedicine. The goal of the TMS program was to reduce stress and burnout, as well as relieve in-clinic staff of telemedicine duties giving them capacity to address in-clinic COVID related staff shortages. Results: The TMS Program supported 15,500 visits (11/15/21 – 5/31/22) and increased upfront expected copay collection from 9% pre-program to 100% post program. The program reduced the time for first contact on video from 18 minutes to 1 minute and reduced the telemedicine cancellation rate by 3%. The supported TM cancellation rate was 7% lower than in-person visit cancellation rate. A geographically distributed work from home team was able to support a 66% increase in visits during inclement weather days which allowed visits to be completed that would have otherwise been canceled due to clinic closures. Additionally, the TMS program relieved workload for in-clinic staff and the VPSC and VMA positions proved highly desirable to the eligible workforce. Conclusions: The TMS Program improved patient connectivity and experience, increased upfront co-pay collection, decreased burden on in-clinic staff, allowed continuity of care during inclement weather, and was an attractive work option for staff. Due to its success, the program moved past pilot phase into an operational program.